PT  - JOURNAL ARTICLE
AU  - D-Yin Lin
AU  - Craig Morrison
AU  - Brigid Brown
AU  - Alexander Andrew Saies
AU  - Reshma Pawar
AU  - Marthinus Vermeulen
AU  - Stewart Robert Anderson
AU  - Tsai Sheng Lee
AU  - Job Doornberg
AU  - Hidde Maarten Kroon
AU  - Ruurd Lukas Jaarsma
TI  - Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial
AID  - 10.1136/rapm-2020-102315
DP  - 2021 Feb 26
TA  - Regional Anesthesia & Pain Medicine
PG  - rapm-2020-102315
4099  - http://rapm.bmj.com/content/early/2021/03/03/rapm-2020-102315.short
4100  - http://rapm.bmj.com/content/early/2021/03/03/rapm-2020-102315.full
AB  - Background The femoral nerve block (FNB) may be used for analgesia in hip fracture surgery. The pericapsular nerve group (PENG) block is a novel regional technique and may provide better pain reduction while preserving motor function, but these blocks have not been directly compared.Methods In a single-center double-blinded randomized comparative trial, patients presenting for hip fracture surgery received analgesia with either FNB or PENG block. The primary outcome measure was pain scores (Numeric Rating Scale (NRS) 0 to 10). Secondary outcomes were postoperative quadriceps strength, opiate use, complications, length of hospital stay, and patient-reported outcomes.Results Sixty patients were randomized and equally allocated between groups. Baseline demographics were similar. Postoperatively in recovery (day 0), the PENG group experienced less pain compared with the FNB group. (In the PENG group, 63% experienced no pain, 27% mild pain, and 10% moderate to severe pain. In comparison, 30% of the FNB group reported no pain, 27% mild pain, and 36% moderate to severe pain; p=0.04). This was assessed using an 11-point Likert NRS. Quadriceps strength was better preserved in the PENG group in the recovery unit (assessed using Oxford muscle strength grading, 60% intact in the PENG group vs none intact in the FNB group; p<0.001) and on day 1 (90% intact vs 50%, respectively; p=0.004). There was no difference in other outcomes.Conclusions Patients receiving a PENG block for intraoperative and postoperative analgesia during hip fracture surgery experience less postoperative pain in the recovery room with no difference detected by postoperative day 1. Quadriceps strength was better preserved with the PENG block. Despite the short-term analgesic benefit and improved quadriceps strength, there were no differences detected in the quality of recovery.